Carbon Dioxide Insufflation in Colonoscopy Is Safe: A Prospective Trial of 347 Patients

M. Geyer,U. Guller,Ch. Beglinger

doi:10.1155/2012/692532

M. Geyer, U. Guller + Show 1 more

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https://doi.org/10.1155/2012/692532

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Abstract

Available evidence suggests that the use of CO2 insufflation in endoscopy is more comfortable for the patient. The safety of CO2 use in colonoscopy remains contentious, particularly in sedated patients. The objective of the present prospective trial was to assess the safety of CO2 colonoscopies. Methods. 109 patients from our previous randomized CO2 colonoscopy study and an additional 238 subsequent consecutive unselected patients who had a routine colonoscopy performed in a private practice were enrolled from April 2008 through September 2008. All but 2 patients were sedated. All patients were routinely monitored with transcutaneous CO2 measurement. Volumes of CO2 administered were correlated with capnographic measurements from transcutaneous monitoring. Results. Of the 347 patients examined, 57% were women; mean (SD) age of participants was of 60.2 years (12.8). Mean propofol dosage was 136 mg (64 mg). Mean CO2 values were 34.7 mm Hg (5.3) at baseline, 38.9 mm Hg (5.5) upon reaching the ileum, and 36.9 mm Hg (5.0) at examination's end. Mean maximum increase of CO2 was 4.5 mm Hg (3.6). No correlation was observed between volume of CO2 administered and increase in level of CO2 (correlation coefficient: 0.01; P value: 0.84). No complications were observed. Conclusions. The present prospective study, which was based on one of the largest sedated patient sample reported to date in this setting, provides compelling evidence that CO2 insufflation in colonoscopy is safe and unassociated with relevant increases in transcutaneously measured levels of CO2.

Highlights

For almost 2 decades, CO2 insufflation with carbon dioxide (CO2) has been widely used in laparoscopic surgery
Available evidence suggests that the use of CO2 insufflation in endoscopy is more comfortable for the patient
The present prospective study, which was based on one of the largest sedated patient sample reported to date in this setting, provides compelling evidence that CO2 insufflation in colonoscopy is safe and unassociated with relevant increases in transcutaneously measured levels of CO2

Summary

Introduction

For almost 2 decades, CO2 insufflation with carbon dioxide (CO2) has been widely used in laparoscopic surgery. Insufflation with room air has remained the standard of care in the vast majority of endoscopy centers in both Europe and North America. Many patients still experience pain and discomfort after colonoscopy with room air insufflation. In the setting of colonoscopy, current scientific data with regard to the safety of CO2 insufflation are limited. Small patient populations have characterized most studies, including those with sedated patients, and many physicians remain concerned that CO2 insufflation might lead to CO2 retention. In a previous randomized, controlled, double-blinded trial, we randomly allocated 219 patients to colonoscopy with CO2 versus room air, patients in the CO2 group experienced significantly less pain and bloating and a higher overall satisfaction score [10]. This study was not designed to definitively demonstrate the safety of CO2 insufflation in colonoscopy. We sought to prospectively assess the safety of CO2 colonoscopy in a larger sample of patients

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